The ethnic inequalities in our mental health service cannot continue

Jeremy Corbyn's creation of a ministerial post dedicated to mental health was welcome and long overdue. This week we're looking at some of the problems facing mental health services in the UK, and what can be done

There are alarming ethnic inequalities in mental healthcare in the UK. Access to quality treatment is inadequate for everyone at the moment, but if you are from a Black or Minority Ethnic (BME) background it’s likely to be even worse.

BME experience in mental health services became a national issue surrounding the 2004 inquiry into the death of David Bennett, a 38-year-old African-Caribbean man suffering from schizophrenia. The report found that Bennett was, in his sister’s words, treated ‘like a lesser being’ in the series of events that led to his being forcibly restrained for almost 25 minutes.

Research over the last 50 years has repeatedly shown that BME communities have more adverse experiences and worse outcomes within mental health care than the rest of the population. The Joint Commissioning Panel for Mental Health (JCPMH) says that ‘ethnic differences are apparent in most aspects of mental health care in the UK’ and that different ethnicities report different experiences of access to care and treatment, choice of treatment, length of stay in hospitals and quality of care.

According to the charity Mind, BME people with mental health problems are more likely to present ‘in crisis’, appearing at A&E or being referred by police. This suggests insufficient access to community support services or home treatment, as well as a reluctance to seek help until the last minute.

This is likely due to fear and mistrust because of differences in the way BME patients are treated. In 2013 less than 40 per cent of white British and Irish inpatients were subject to detention under the Mental Health Act compared to over 60 per cent of inpatients from BME backgrounds.

The outcomes of treatment are also more likely to be negative. The latest data from the Health and Social Care Information Centre (HSCIC) showed that among people referred to psychological therapies in the past year, there has been a significantly higher ‘recovery’ rate for white people than for BME people.

Obviously, these inequalities do not only begin when someone enters the healthcare system. BME people across the UK are more likely to be in poverty or suffering from ill health. An ONS study on subjective wellbeing and happiness found that the groups who reported the lowest average rating out of 10 for ‘life satisfaction’ were the ‘Black/African/Caribbean/Black British’ group (6.7), the ‘Bangladeshi’ group (7.0), the ‘Arab’ group (7.1), and the ‘Mixed/Multiple ethnic’ groups (7.1). These ratings were all significantly lower than for the ‘White’ group who reported an average of 7.4 out of 10.

So what can be done to reduce ethnic inequalities in mental healthcare? Jeremy Corbyn’s welcome focus on mental health is an opportunity to develop new strategies for addressing this problem. In both the long and short term, we need to consider:

That lack of appropriate understanding of racism that exists within the mental healthcare system perpetuates the problem. Put simply, if a young black man with a mental health problem expects to be treated like a criminal by staff he will be unlikely to seek help. Experience of racism in wider society may exacerbate this problem. (David Bennett’s problems were repeatedly blamed on marijuana use).

Conducting an inquiry into higher rates of compulsory detention among BME inpatients and developing systems to better ensure that use of detention, and use of force, are always appropriate. Noone should ever be afraid to approach the health service.

That lack of information about mental health may prevent people from BME communities from seeking help. Different cultural frames of reference may affect how a person with mental illness is viewed in their community. Better education in schools with high BME populations would be one way to reduce the stigma surrounding mental illness and encourage understanding.

Psychological distress and complex emotions often need mother tongue communication. It is important that enough health professionals within BME communities are trained to offer support in patients’ own language. A mental health worker should be able to support a patient in what Mind calls ‘the context of their whole life’ which may point to specific cultural or religious components. Peer or survivor-led groups could be one way to approach this.

Recording and measuring the experiences of service users should be routine.

Of course, much of this is dependent on better funding, but costs could be reduced if there was more focus on prevention, with educational and community initiatives intervening before people end up in A&E. Mental health costs the economy as much as £70m a year – the status-quo is not working economically any more than it is working for vulnerable people.

HaroldAMaio

damon

I asked a physiatrist I know about some of these claims about racism in mental health services a few years ago and he said they were basically BS.

I had listened to a weekly London radio show on BBC London where they talk about race issues, and they had a couple of women from the group ”Black Mental Health” in the studio to discuss the issue.
My friend the physiatrist – who grew up in India and came to the UK as an adult, dismissed these kinds of people out of hand. He was constantly getting memos and information about the supposed problem, and he said he ignored most or all of it.

Mann T.

The high incidence of mental health problems in London is with Afro-Caribbeans not BME folk in general. Broken families, chaotic family life, anger everywhere with young incompetent mothers and hatred of schools among the kids do not provide the context for raising kids with balanced minds and calm souls.

The problem is not simply psychological regarding individuals. It is sociological regarding whole communities. But we are very poorly equipped with methodologies or resources to deal with communities and most community interventions fail miserably.